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International audience; Objective: 25-hydroxyvitamin D (25OHD) deficiency has been associated with sleep disorders in adults. Only three cross-sectional studies were performed in children and showed an association between 25OHD deficiency and both obstructive sleep apnea syndrome and primary snoring. No longitudinal study has been performed in children from the general population. We analyzed the association between cord-blood vitamin D level at birth and night-sleep duration trajectories for children between 2 and 5-6 years old in a non-clinical cohort.Method: We included 264 children from the French EDEN mother-child birth-cohort with both cord-blood 25OHD level determined by radio-immunoassay at birth, and night-sleep trajectories for children between 2 and 5-6 years old obtained by the group-based trajectory modeling method. Associations between 25OHD and sleep trajectories were assessed by multinomial logistic regression adjusted for maternal and child characteristics.Results: The trajectories short sleep (

International audience; Non-alcoholic fatty liver disease (NAFLD) is a highly prevalent chronic liver disease that occurs mostly in the context of insulin resistance and obesity. It has rapidly evolved into the most common cause of liver disease among children. The incidence is high in obese children and a greater risk of disease progression is associated with severe obesity, highlighting the role of nutrition. To date, there is no consensus on NAFLD management. This is a narrative review of clinical studies on the potential benefit of nutritional interventions, including lifestyle modifications, vitamins, docosahexaenoic acid, and probiotics in children with NAFLD. The Comit e de nutrition de la Soci et e Française de P ediatrie (CN-SFP) emphasizes the effect of limiting added sugar intake, i.e., fructose or sucrose-containing beverages, and promoting physical activity in the care of NAFLD.

International audience; Objective. Sleep duration may vary inter-individually and intra-individually over time. We aimed at both identifying night-sleep duration (NSD) trajectories among preschoolers and studying associated factors. Methods. NSD were collected within the French birth-cohort study EDEN at ages 2, 3 and 5-6 years through parental questionnaires, and were used to model NSD trajectories among 1205 children. Familial socioeconomic factors, maternal sociodemographic, health and lifestyle characteristics as well as child health, lifestyle, and sleep characteristics at birth and/or at age 2 years were investigated in association with NSD using multinomial logistic regressions. Results. Five distinct NSD trajectories were identified: short (SS

International audience; Background and aims: Cardiovascular risk is high in heterozygous familial hypercholesterolemia (HeFH). The objective of this study was to describe recurrent cardiovascular events in selected patients with HeFH attending lipid clinics in France. Methods: We included 781 patients with a clinical (Dutch Lipid Clinic Network score \textgreater= 6) or genetic diagnosis of HeFH who had experienced a first cardiovascular event (myocardial infarction, percutaneous coronary intervention or coronary bypass, unstable angina, stroke, peripheral arterial revascularization or cardiovascular death) and were enrolled in the French Familial Hypercholesterolemia Registry (November 2015 to March 2018). Results: The first cardiovascular event occurred at the mean age of 47 years (interquartile range 39-55) in a predominantly male population (72%); 48% of patients were on statin therapy. Overall, 37% of patients had at least one recurrent cardiovascular event (mean of 1.8 events per patient), of which 32% occurred in the 12 months after the index event; 55% of events occurred \textgreater 3 years after the first event. Mean LDL-C at the last clinic visit was 144 +/- 75 mg/dL (132 +/- 69 mg/dL for patients on high-potency statin therapy and 223 +/- 85 mg/dL for untreated patients). Conclusions: The rate of recurrent cardiovascular events was high in French patients with HeFH in secondary prevention. The detection of FH during childhood is crucial to prevent CV events at a young age by early initiating statin therapy. There is a clear urgent need to expand the actual very small target population which can be treated with the PCSK9 inhibitor in France.

Objective The aim was to study, with a developmental approach, the longitudinal association between night-waking from age 2 to 5–6 years and behavior at age 5–6 years. Methods Within the French birth cohort study Etude sur les Determinants pre et post natals du developpement et de la sante de l'ENfant (EDEN), repeated measures of children's night-waking were collected at age 2, 3 and 5–6 through parental questionnaires and were used to model night-waking trajectories. Behavior was assessed with the “Strengths and Difficulties Questionnaire,” which provides five subscales measuring a child's conduct problems, emotional symptoms, peer relation problems, antisocial behavior, and hyperactivity/attention problems. The behavioral subscales were dichotomized at the tenth percentile. Multivariable logistic regressions, adjusted for parents' socio-economic factors, parental characteristics, and children's characteristics and sleep habits allowed us to study, in 1143 children, the association between night-waking trajectories from 2 to 5–6 years and behavior at age 5–6 years. Results The “2 to 5–6 rare night-waking” trajectory represented 78% of the included population (n = 896), and the “2 to 5–6 common night-waking” 22% (n = 247%). Children belonging to the “2 to 5–6 common night-waking trajectory” had, at age 5–6, increased risk of presenting emotional symptoms (odds ratio [OR] = 2.17, 95% CI = 1.27–3.70, p = 0.004), conduct problems (OR = 1.63, 95% CI = 1.00–2.65, p = 0.050), and hyperactivity/attention problems (OR = 1.61, 95% CI = 1.00–2.57, p = 0.049). After adjusting for baseline behavior at age two years, only the association with emotional symptoms remained significant (OR = 2.02, 95% CI = 1.15–3.55, p = 0.015). Results did not differ according to sex. Conclusion Results suggest that the persistence of night-waking difficulties in early years is positively associated with emotional symptoms, hyperactivity/inattention, and conduct problems.

Resume Il existe des le jeune âge une relation entre la consommation de sodium et le niveau de la pression arterielle, ce qui justifie de controler les apports sodes chez les enfants. Cependant, les besoins en sodium a cet âge ne sont pas connus de facon precise. Cet article fait le point sur les apports souhaitables de sodium en fonction de l’âge selon differents groupes d’experts, sur les niveaux d’apport observes dans les enquetes de consommation et sur les strategies de sante publique mises en place pour reduire la consommation de sel dans la population pediatrique. Des recommandations pratiques sont proposees par le Comite de nutrition de la Societe francaise de pediatrie pour limiter la consommation de sel chez les enfants.

Resume La denutrition proteino-energetique est l’etat pathologique resultant d’une inadequation entre les besoins et les apports proteino-energetiques. Elle peut entrainer une augmentation de la morbidite voire de la mortalite d’une eventuelle pathologie sous-jacente. Le Comite de nutrition de la Societe francaise de pediatrie recommande de peser et de mesurer tout enfant quel que soit le contexte de visite ou d’hospitalisation. En l’absence d’information sur la cinetique de la croissance, l’indice de masse corporelle (IMC) doit etre calcule et interprete en fonction des courbes de reference figurant dans le carnet de sante. Pour tout IMC inferieur au troisieme percentile pour l’âge et le sexe, il est recommande d’examiner l’enfant a la recherche de signes cliniques de denutrition ou de signes orientant vers son origine et de noter dans le dossier l’evolution de la croissance staturo-ponderale (IMC et taille). Une strategie nutritionnelle integree a la prise en charge globale de l’enfant sera alors etablie. Elle suppose de definir le poids cible et d’adapter les apports proteino-energetiques en termes qualitatif, quantitatif, et de modalites d’administration (orale, enterale, parenterale). Dans tous les cas, cette attitude sera evaluee et adaptee selon l’effet obtenu.

Resume La denutrition proteino-energetique est l’etat pathologique resultant d’une inadequation entre les besoins et les apports proteino-energetiques. Elle est deletere par ses consequences fonctionnelles et structurelles (perte tissulaire) et peut entrainer une augmentation de la morbidite voire de la mortalite d’une eventuelle pathologie sous-jacente. Le Comite de nutrition de la Societe francaise de pediatrie (SFP) recommande de peser et de mesurer tout enfant quel que soit le contexte de visite ou d’hospitalisation. En l’absence d’information sur la cinetique de la croissance, l’indice de masse corporelle (IMC) doit etre calcule et interprete en fonction des courbes de reference figurant dans le carnet de sante. Pour tout IMC inferieur au 3 e percentile pour l’âge et le sexe, il est recommande : (1) d’examiner l’enfant a la recherche de signes cliniques de denutrition ou de signes orientant vers son origine ; (2) de tracer l’evolution de la croissance staturoponderale (IMC et taille). Toute denutrition, qu’elle soit identifiee en pediatrie communautaire ou en milieu hospitalier, necessite d’etablir une strategie nutritionnelle integree a la prise en charge globale de l’enfant. Elle suppose de definir le poids cible et d’adapter les apports proteino-energetiques en termes de niveaux, de composition et de modalites d’administration (orale, enterale, parenterale). Dans tous les cas, cette attitude sera evaluee et adaptee selon l’effet obtenu.

As early-life feeding experiences may influence later health, we aimed to examine relations between feeding patterns over the first year of life and child's growth in the first 5 years of life.Our analysis included 1022 children from the EDEN mother-child cohort. Three feeding patterns were previously identified, i.e. 'Later dairy products introduction and use of ready-prepared baby foods' (pattern-1), 'Long breastfeeding, later main meal food introduction and use of home-made foods' (pattern-2) and 'Use of ready-prepared adult foods' (pattern-3). Associations between the feeding patterns and growth [weight, height and body mass index {BMI}] were analysed by multivariable linear regressions. Anthropometric changes were assessed by the final value adjusted for the initial value.Even though infant feeding patterns were not related to anthropometric measurements at 1, 3 and 5 years, high scores on pattern-1 were associated with higher 1-3 years weight and height changes. High scores on pattern-2 were related to lower 0-1 year weight and height changes, higher 1-5 years weight and height changes but not to BMI changes, after controlling for a wide range of potential confounding variables including parental BMI. Scores on pattern-3 were not significantly related to growth. Additional adjustment for breastfeeding duration reduced the strength of the associations between pattern-2 and growth but not those between pattern-1 and height growth.Our findings emphasize the relevance of considering infant feeding patterns including breastfeeding duration, age of complementary foods introduction as well as type of foods used when examining effects of early infant feeding practices on later health. © 2017 World Obesity Federation.

Protein energy malnutrition (PEM) occurs when energy and protein intake do not meet requirements. It has a functional and structural impact and increases both morbidity and mortality of a given disease. The Nutrition Committee of the French Pediatric Society recommends weighing and measuring any child when hospitalized or seen in consultation. The body mass index (BMI) must be calculated and analyzed according to references any time growth kinetics cannot be analyzed. Any child with a BMI below the third centile or -2 standard deviations for age and sex needs to be examined looking for clinical signs of malnutrition and signs orienting toward an etiology and requires having his BMI and height dynamics plotted on a chart. PEM warrants drawing up a nutritional strategy along with the overall care plan. A target weight needs to be determined as well as the quantitative and qualitative nutritional care including its implementation. This plan must be evaluated afterwards in order to adapt the nutritional therapy.

Introduction Des changements de couleur de cheveux peuvent etre observes lors de maladies systemiques, metaboliques, nutritionnelles, genetiques ou etre d’origine iatrogene. Nous rapportons le cas d’un nourrisson de 5 mois presentant une hypomelanose en bandes pilaires acquises de cause vraisemblablement carentielle. Observation Un nourrisson mâle de 5 mois, ne a terme par voie basse, d’origine franco-chinoise, etait hospitalise depuis la naissance pour un syndrome polymalformatif associant tetralogie de Fallot et atresie de l’œsophage severe, pour laquelle il etait gastrotomise. Son caryotype etait normal. Durant l’hospitalisation, plusieurs complications infectieuses bacteriennes etaient survenues. Un avis dermatologique etait demande pour une heterochromie acquise des cheveux. A l’examen clinique, ses cheveux, naturellement fonces, etaient marques par la presence de 3 bandes claires horizontales, sur l’ensemble des cheveux. Il n’y avait pas d’alopecie, de fragilite capillaire, de lesion cutanee sous-jacente sur le cuir chevelu. L’examen de la peau, de la cavite buccale et des ongles etait normal. La biologie de routine et les dosages de TSH et vitaminiques etaient normaux. L’analyse au microscope electronique a balayage montrait un diametre moyen normal et homogene des cheveux (56 μm) et une dysplasie pilaire, sur deux tiers des tiges pilaires, liee a des anomalies de deformation (torsions, aplatissement et sillons longitudinaux) sans discrimination entre les zones subnormales et hypopigmentees. L’analyse de la composition isotopique azotee (N15/N14) des cheveux est en cours. La courbe d’indice de masse corporelle (IMC) du nourrisson affichait 3 periodes d’inflexion depuis la naissance, au cours desquelles l’IMC avait chute du fait de l’atresie œsophagienne et d’infections bacteriennes. Il est vraisemblable que les 3 bandes pilaires hypopigmentees refletent ces periodes de denutrition. Aucun des medicaments administres n’a pu etre incrimine ( Fig. 1 et 2 ). Discussion L’alternance de bandes claires et foncees sur les cheveux correspond au « signe du drapeau » (flag sign). Les causes rapportees dans la litterature sont principalement iatrogenes (inhibiteurs des tyrosines kinases, etc.), mais aussi metaboliques et carentielles (malnutrition proteinoenergetique ou syndrome de Kwashiorkor). Ces fortes denutritions sont observees plus frequemment dans les pays en voie de developpement, ou elles s’accompagnent d’autres signes generaux. La physiopathologie de cet eclaircissement de couleur des cheveux au cours de la denutrition severe est mal comprise, et pourrait etre liee a une teneur totale en melanine diminuee, par baisse d’apport en tyrosine, substrat-cle dans la synthese de la melanine. Conclusion Le signe du drapeau peut traduire une denutrition severe, y compris chez les nourrissons, dont la chronologie est en lien avec le rythme de repousse de cheveux.

New data on food allergy has recently changed the management of children with cow's milk protein allergy (CMPA). The diagnosis of CMPA first requires the elimination of cow's milk proteins and then an oral provocation test following a standard diagnostic procedure for food allergy, without which the elimination diet is unjustified and sometimes harmful. Once the diagnosis is made, the elimination diet is strict, at least until the age of 9-12 months. If the child is not breastfed or the mother cannot or no longer wishes to breastfeed, the first choice is a formula based on extensive hydrolyzate of cow's milk (eHF), provided that its effectiveness has been demonstrated. When eHF fails, a formula based on amino acids is warranted. eHF based on rice protein hydrolysates is an alternative to cow's milk eHF. Infant formulas based on soy protein can be used after the age of 6 months, after verification of good clinical tolerance to soy. Most commonly, CMPA disappears within 2 or 3 years of life. However, the age of recovery varies depending on the child and the type of CMPA, and whether or not it is IgE-mediated, the first being more sustainable. When the child grows, a hospital oral provocation test evaluates the development of tolerance and, if possible, authorizes continuing the reintroduction of milk proteins at home. Some children with CMPA will tolerate only a limited daily amount of cow's milk proteins. The current therapeutic options are designed to accelerate the acquisition of tolerance, which seems facilitated by regular exposure to cow's milk proteins.

The prevalence of breastfeeding in France is one of the lowest in Europe: 65% of infants born in France in 2010 were breastfed when leaving the maternity ward. Exclusive breastfeeding allows normal growth until at least 6 months of age, and can be prolonged until the age of 2 years or more, provided that complementary feeding is started after 6 months. Breast milk contains hormones, growth factors, cytokines, immunocompetent cells, etc., and has many biological properties. The composition of breast milk is influenced by gestational and postnatal age, as well as by the moment of the feed. Breastfeeding is associated with slightly enhanced performance on tests of cognitive development. Exclusive breastfeeding for at least 3 months is associated with a lower incidence and severity of diarrhoea, otitis media and respiratory infection. Exclusive breastfeeding for at least 4 months is associated with a lower incidence of allergic disease (asthma, atopic dermatitis) during the first 2 to 3 years of life in at-risk infants (infants with at least one first-degree relative presenting with allergy). Breastfeeding is also associated with a lower incidence of obesity during childhood and adolescence, as well as with a lower blood pressure and cholesterolemia in adulthood. However, no beneficial effect of breastfeeding on cardiovascular morbidity and mortality has been shown. Maternal infection with hepatitis B and C virus is not a contraindication to breastfeeding, as opposed to HIV infection and galactosemia. A supplementation with vitamin D and K is necessary in the breastfed infant. Very few medications contraindicate breastfeeding. Premature babies can be breastfed and/or receive mother's milk and/or bank milk, provided they receive energy, protein and mineral supplements. Return to prepregnancy weight is earlier in breastfeeding mothers during the 6 months following delivery. Breastfeeding is also associated with a decreased risk of breast and ovarian cancer in the premenopausal period, and of osteoporosis in the postmenopausal period.

Very early in life, sodium intake correlates with blood pressure level. This warrants limiting the consumption of sodium by children. However, evidence regarding exact sodium requirements in that age range is lacking. This article focuses on the desirable sodium intake according to age as suggested by various groups of experts, on the levels of sodium intake recorded in consumption surveys, and on the public health strategies implemented to reduce salt consumption in the pediatric population. Practical recommendations are given by the Committee on nutrition of the French Society of Pediatrics in order to limit salt intake in children.

The aim of this study was to investigate whether insulin resistance-associated in utero undernutrition was related to changes in insulin action on gene expression of molecules involved in the insulin signaling pathway and peripheral glucose metabolism in muscle and adipose tissue. Thirteen insulin-resistant subjects born with intrauterine growth retardation (IUGR) were matched for age, gender, and body mass index to 13 controls. Gene expression of insulin receptor, insulin receptor substrate-1, p85α phosphatidylinositol 3-kinase, glucose transporter-4 (GLUT4), hexokinase II, and glycogen synthase was studied in skeletal muscle at baseline and after a 3-h euglycemic insulin stimulation. Target messenger ribonucleic acid (mRNA) levels were quantified using the RT-competitive PCR method. Insulin-stimulated glucose uptake was significantly lower in IUGR-born subjects than in controls (36.9± 12, 7 vs. 53.9 ± 12.7 μmol/kg·min; P = 0.007), affecting both the glucose oxidation rate and the nonoxidative glucose di...

Processed baby foods designed for infants (4-12 months) and toddlers (12-36 months) (excluding infant formula, follow-on formula, the so-called growing-up milks, and cereal-based foods for infants), which are referred to as baby foods, are specific products defined by a European regulation (Directive 2006/125/CE). According to this Directive, such foods have a composition adapted to the nutritional needs of children of this age and should comply with specifications related to food safety in terms of ingredients, production processes, and prevention of infectious and toxicological hazards. Hence, they differ from ordinary foods and from non-specific processed foods. This market segment includes the full range of foods that can be part of children's diet: dairy products (dairy desserts, yoghurts, and fresh cheese), sweet products (nondairy desserts, fruit, and drinks), and salty products (soups, vegetable-based foods, meat, fish, and full dishes). This market amounted to 89,666 MT in France in 2011 and 83,055 MT in 2010 (a total of 325,524 MT in the 27 countries of the European Union in 2010, including 90,438 MT in Germany, 49,144 MT in Spain, and 40,438 MT in Italy). The consumption of baby foods in France varies with infant age and parental choice. Baby foods account for 7 % of total energy intake at 4-5 months, 28 % at 6-7 months, 27 % at 8-11 months, 17 % at 1-17 months, and 11 % at 18-24 months. Among parents, 24 % never offer their children any baby foods, 13 % do so 1-3 days/week and 63 % 4-7 days/week. Among consumers, 55 % of children eat more than 250 g/day of baby foods. As baby foods only account for a minor fraction of overall food intake, their impact on the quality of young children's diet is much less than that of growing-up milks, particularly for preventing insufficient iron and vitamin D intake. Their consumption, however, has an indirect benefit on the nutritional quality of the diet and on food safety, particularly regarding toxicological hazards, as it postpones the introduction of non-specific processed foods, which are inadequate for this age group owing to both their nutritional composition and lower food safety control. Baby foods represent a family of products meeting parents' expectations and adapted to infants and young children. They are clearly beneficial in terms of food safety, but the nutritional benefit to be expected from their consumption is minimal: their main advantage is postponing or decreasing the consumption of non-specific industrially processed foods.

Protein energy malnutrition (PEM) occurs when energy and protein intake do not meet requirements. It has a functional and structural impact and increases both morbidity and mortality of a given disease. The Nutrition Committee of the French Pediatric Society recommends weighing and measuring any child when hospitalized or seen in consultation. The body mass index (BMI) must be calculated and analyzed according to references any time growth kinetics cannot be analyzed. Any child with a BMI below the third centile or -2 standard deviations for age and sex needs to be examined looking for clinical signs of malnutrition and signs orienting toward an etiology and requires having his BMI and height dynamics plotted on a chart. PEM warrants drawing up a nutritional strategy along with the overall care plan. A target weight needs to be determined as well as the quantitative and qualitative nutritional care including its implementation. This plan must be evaluated afterwards in order to adapt the nutritional therapy.

New data on food allergy has recently changed the management of children with cow's milk protein allergy (CMPA). The diagnosis of CMPA first requires the elimination of cow's milk proteins and then an oral provocation test following a standard diagnostic procedure for food allergy, without which the elimination diet is unjustified and sometimes harmful. Once the diagnosis is made, the elimination diet is strict, at least until the age of 9-12 months. If the child is not breastfed or the mother cannot or no longer wishes to breastfeed, the first choice is a formula based on extensive hydrolyzate of cow's milk (eHF), provided that its effectiveness has been demonstrated. When eHF fails, a formula based on amino acids is warranted. eHF based on rice protein hydrolysates is an alternative to cow's milk eHF. Infant formulas based on soy protein can be used after the age of 6 months, after verification of good clinical tolerance to soy. Most commonly, CMPA disappears within 2 or 3 years of life. However, the age of recovery varies depending on the child and the type of CMPA, and whether or not it is IgE-mediated, the first being more sustainable. When the child grows, a hospital oral provocation test evaluates the development of tolerance and, if possible, authorizes continuing the reintroduction of milk proteins at home. Some children with CMPA will tolerate only a limited daily amount of cow's milk proteins. The current therapeutic options are designed to accelerate the acquisition of tolerance, which seems facilitated by regular exposure to cow's milk proteins.

Homozygous familial hypercholesterolemia (HFH) is a rare genetic disease associated with increased atherosclerosis, resulting in premature death near the age of 20 years. Treatment requires the LDL-apheresis system. M, born from a consanguineous union, suffers from HFH (total-cholesterol=12.29 g/l, LDL-cholesterol=9.65 g/l). Diet and drug treatment was not associated with decreased LDL-cholesterol. At the age of 4.5 years (body weight: 16.7 kg), M began treatment with LDL-apheresis. Apheresis treatment was given every 2 weeks using the Direct Adsorption of LIpoprotein (DALI system, a process that involves total-blood filtration. During the first 26 sessions, the mean reduction in LDL-cholesterol was 67+/-12%, while HDL-cholesterol decreased by only 17+/-11%. Mean LDL-cholesterol concentration decreased from 6.54+/-0.93 g/l (before apheresis) to 2.21+/-0.95 g/l (after apheresis). Apart from iron deficiency anemia, no major side effects were observed. LDL-apheresis using the DALI system is associated with significant reductions in LDL-cholesterol (similar to reports from the literature) without major side effects, even in a child weighing less than 20 kg. A long term, multinational (European) study is needed to confirm these results.

A few studies report malnutrition in hospitalized patients.This one-day cross-sectional survey performed in January 1999 assessed nutritional status and protein-energy intake in a pediatric population hospitalized in medicine or surgery units. Every child older than six months, hospitalized for more than 48 h and free of nutritional support (parenteral, enteral, or special regimens for metabolic diseases) was included.Fifty-eight children among the 183 present the day of the study met the inclusion criteria and were included in the statistical analysis. They were hospitalized in medicine (48%), psychiatry (31%) and surgery (21%). The body mass index (BMI) was below -2 standard deviations (DS) in 21% of them. Excluding patients with anorexia nervosa, BMI was-2 SD,+2 SD, or in between these limits in respectively 12, 14 and 74%. Energy intake measured at the hospital was below 75% of the recommended dietary allowances in two-thirds of the children whether malnourished or not. Fifty percent of the malnourished children had been referred to a dietician the day of the study.Malnutrition is frequent in a population of hospitalized children. Energy intake and referral to a dietician are insufficient.

Data on the proton pump inhibitor lansoprazole in paediatric patients are limited.To investigate the pharmacokinetics, optimal dosage and efficacy of lansoprazole in paediatric patients.A 24-h gastric pH recording and a pharmacokinetic study were performed after 7 days of lansoprazole, 17 mg/m2, in 23 patients with reflux oesophagitis (median age, 3.5 years). Response was defined as pH3 for65% of the recording. The dosage was doubled in non-responders. Patients with no response on day 14 were excluded. Responders underwent endoscopy after 4 weeks on the response-inducing dosage; abnormal findings led to a repeat endoscopy after four additional weeks.Nine patients responded to 17 mg/m2 and six to 30.3 mg/m2. On day 7, time with pH3 was significantly correlated with the area under the plasma concentration-time curve (P=0.003). The area under the plasma concentration-time curve was significantly greater in the nine responders to 17 mg/m2 than in the 14 other patients. Pharmacokinetic parameters were similar in responders and non-responders to the higher dose. After 4 weeks, oesophagitis was healed in 80% of responders. Adverse events occurred in three patients and required treatment discontinuation in one.Lansoprazole is effective and safe in children. The optimal starting dosage is 30 mg/m2 or 1.4 mg/kg.

The aim of this study was to investigate whether insulin resistance-associated in utero undernutrition was related to changes in insulin action on gene expression of molecules involved in the insulin signaling pathway and peripheral glucose metabolism in muscle and adipose tissue. Thirteen insulin-resistant subjects born with intrauterine growth retardation (IUGR) were matched for age, gender, and body mass index to 13 controls. Gene expression of insulin receptor, insulin receptor substrate-1, p85alpha phosphatidylinositol 3-kinase, glucose transporter-4 (GLUT4), hexokinase II, and glycogen synthase was studied in skeletal muscle at baseline and after a 3-h euglycemic insulin stimulation. Target messenger ribonucleic acid (mRNA) levels were quantified using the RT-competitive PCR method. Insulin-stimulated glucose uptake was significantly lower in IUGR-born subjects than in controls (36.9 +/- 12, 7 vs. 53.9 +/- 12.7 micromol/kg.min; P = 0.007), affecting both the glucose oxidation rate and the nonoxidative glucose disposal rate. At baseline, the expression of the six genes in muscle did not significantly differ between the two groups. The insulin-induced changes over baseline were comparable in both groups for all mRNAs, except GLUT4. In contrast to what observed in the control group (mean increment, 49 +/- 23%; P = 0.0009), GLUT4 expression was not stimulated by insulin in the IUGR group (8 +/- 8%; P = 0.42). Moreover, the magnitude of the defect in GLUT4 mRNA regulation by insulin was correlated to the degree of insulin resistance (r = 0.73; P = 0.01). A similar lack of significant GLUT4 mRNA stimulation by insulin was observed in the adipose tissue of IUGR-born subjects. In conclusion, insulin resistance in IUGR-born subjects is associated with an impaired regulation of GLUT4 expression by insulin in muscle and adipose tissue. Our data provide additional information about the mechanism of insulin resistance associated with in utero undernutrition and strengthen the role of glucose transport in the control of insulin sensitivity.

Introduction et but de l’etude La myopathie de Duchenne de Boulogne (MDB) se caracterise par une perte progressive des fibres musculaires avec remplacement par du tissu adipeux (depots intramusculaires de lipides). L’estimation de la composition corporelle par l’impedancemetrie (BIA) et l’anthropometrie n’est pas validee dans la MDB. Dans un travail precedent realise chez des myopathes plus âges (10.0±2,5 ans), la BIA evaluait la composition corporelle avec une meilleure precision que la mesure anthropometrique des plis cutanes. Le but de l’etude a ete de comparer deux methodes d’estimation de la composition corporelle (BIA versus mesure anthropometrique des plis cutanes) a une methode de reference, l’absorptiometrie biphotonique (DXA) chez les enfants atteints de MDB en stratifiant par l’âge. Materiel et methodes 30 enfants atteints la MDB (20 enfants âges 7 ans) ont ete evalues par BIA (50 KHz, 800 mAmp), la mesure des plis cutanes et par DXA. La masse maigre (MM) et le pourcentage masse grasse (%MG) ont ete calculees par les formules de Houtkopper (BIA) et de Brook (plis cutanes). Les moyennes ±DS ont ete comparees par ANOVA a 1 facteur + test de Tukey. Resultats En moyenne (N=30), l’âge etait de 6.8±2.4 ans (2 a 11 ans), le poids de 20.8±6.3 kg, la taille de 114.9±14.2 cm et l’IMC del5.4±1.4 kg/m2. Tableau 1Plis cutanesBIADXAMM (kg) (N=30)17.5 ± 4.917.6 ± 4.215.3 ± 3.7%MG (N=30)15.4 ± 3.8*14.0 ± 7.9*20.3 ± 8.4MM (kg) 7 ans (n=10)22.5 ± 4.321.5 ± 4.118.6 ± 3.7%MG >7 ans (n=10)17.4 ± 3.4†20.6 ± 6.426.1 ± 8.8*P Conclusions Des differences d’estimation de MM et du %MG existent en fonction de la methode utilisee et varient en fonction de l’âge chez l’enfant myopathe. De facon similaire a notre travail precedent realise chez des myopathes plus âges, la BIA donne une meilleure estimation de la composition corporelle que la mesure des plis cutanes chez l’enfant MDB âge > 7 ans. Un resultat inverse est observe chez les jeunes MDBs âges

Objectifs Diabete et obesite exposent a des complications renales. Une alteration de la sensibilite a l’insuline est l’un des mecanismes de l’atteinte renale precoce chez l’enfant obese. Materiels et methodes Parmi une population d’enfants obeses de grade 2, une echographie abdominale (Acuson Sequoia 512) a ete realisee par le meme operateur, avec doppler intra et extra-renal ainsi qu’un calcul de HOMA, index de sensibilite a l’insuline. Resultats Cinquante et un enfants presentant une obesite de degre 2 ont ete inclus (âge : 11,7 ± 2,7 ans, DV1C : 4,4 ± 0,8). Vingt deux enfants presentaient un HOMA compatible avec une insulino-resistance (IR). Les enfants IR avaient des valeurs plus elevees de pression arterielle systolique ajustee a la taille (115,8 ± 5,3 vs 110,7 ± 5,7 mmHg, p Conclusion Ces donnees d’exploration suggerent que le rein est le lieu de complications precoces chez l’enfant obese avec un HOMA compatible avec une insulinoresistance. L’augmentation de taille des reins est une donnee originale avec des implications sur la physiopathologie mal connue de la nephropathie mais surtout sur le diagnostic et la prise en charge de ces patients.

Objectifs La drepanocytose homozygote est une maladie genetique autosomique recessive ; son incidence est de 1/2 000 naissance. On estime a 4 000 le nombre d’adultes atteints de drepanocytose homozygote en France. Le diagnostic est generalement pose chez l’enfant de 6 a 18 mois en Europe ; la manifestation clinique principale s’exprime par des crises douloureuses abdominales violentes et aussi la survenue d’AVC. Cette etude propose de detecter precocement le risque d’AVC. Materiels et methodes Quinze enfants de 5 a 15 ans atteints de drepanocytose homozygote ont ete explores au CHU de Poitiers. Ils ont beneficie d’un Doppler transcrânien (DTC) et d’une angio-IRM quand le DTC revelait des stenoses intracerebrales. Resultats Une augmentation significative des vitesses au DTC dans les arteres sylviennes a ete retrouvee chez 5 d’entre eux, confirmee par l’angio-IRM qui a valide l’existence de ces stenoses et parfois revele une arterite des arteres de petit calibre (Moya-Moya). Conclusion Le DTC est un examen sensible qui permet de detecter la presence de stenose hemodynamiquement significative au niveau des arteres sylviennes ou de la base du cerveau, complete et valide par une angio-IRM pour evaluer le risque eleve d’accident vasoocclusif cerebral chez l’enfant. La prise en charge therapeutique peut alors etre modifiee.